A Critical Review of Dr. Charles S. Greene's Article titled "Managing the Care of Patients with Temporomandibular Disorders: A New Guideline for Care" and A Revision of the American Association of Dental Research's 1996 Policy Statement on Temporomandibular Disorders, Approved by the AADR Council in March 2010, published in the Journal of the American Dental Association September 2010.

Abstract: Dr. Charles Greene's article, "Managing the Care of Patients with TMDs A New Guideline for Care", and the American Association for Dental Research (AADR) 2010 Policy Statement on Temporomandibular Disorders, published in the Journal of the American Dental Association (JADA) September 2010, are reviewed in detail. The concept that all temporomandibular disorders (TMDs) should be lumped into one policy statement for care is inappropriate. TMDs are a collection of disorders that are treated differently, and the concept that TMDs must only be managed within a biopsychosocial model of care is inappropriate. TMDs are usually a musculoskeletal orthopedic disorder, as defined by the AADR. TMD orthopedic care that is peer-reviewed and evidence-based is available and appropriate for some TMDs. Organized dentistry, including the American Dental Association, and mainstream texts on TMDs, support the use of orthopedics in the treatment of some TMDs. TMDs are not psychological or social disorders. Informed consent requires that alternative care is discussed with patients. Standard of care is a legal concept that is usually decided by a court of law and not decided by a policy statement, position paper, guidelines or parameters of care handed down by professional organizations. The 2010 AADR Policy Statement on TMD is not the standard of care in the United States. Whether a patient needs care for a TMD is not decided by a diagnostic test, but by whether the patient has significant pain, dysfunction and/or a negative change in quality of life from a TMD and they want care. Some TMDs need timely invasive and irreversible care.

Note: This Special Report contains the following statements regarding the TMJ Scale (please see the Special Report for a listing of reference citations):

“McNeill also stated that the TMJ Scale (Pain Resource Center, Inc.) is designed for use by dentists assessing TMD (ref 57), and more comprehensive psychological inventories are not necessary for routine screening" (ref 56).

“The TMJ Scale discriminates between dental patients without a clinical TMD and dental patients with a clinical TMD.The gold standard for test development was a group of 30 TMD dentists in 19 states and Canada utilizing a clinical history and examination guided by a clinical evaluation protocol.” (ref 99)

“The TMJ Scale can also be used to quantitatively measure the effectiveness of treatment, and therefore outcome, by utilizing the TMJ Compare (Pain Resource Center, Inc.) to calculate differences in TMD symptom intensity before and after treatment interventions.”

“These tests, except for the TMJ Scale, usually do not discriminate between those who need chronic TMD care and those who do not.”

Thank you for this well-informed article. It really explains the difference with the discrimination of patients with TMD and those without. I think it is important that patients of who have TMD will be given the proper care they deserve and according to their needs.

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Hello, my name is Steve Levitt and welcome to my Blog. I'm a physician with 34 years of experience treating patients and conducting research on temporomandibular disorders (sometimes called "TMD" or "TMJ") and chronic pain. Prior to my MD, my PhD research involved the study of the inorganic component of teeth and bones. I was an NIH Research Fellow during medical school at Case Western Reserve Univ, and did my Psychiatry Residency at University of North Carolina in Chapel Hill. In 1979 I joined the Clinical Faculty, Dept. of Psychiatry at the U.N.C. School of Medicine. As Adjunct Associate Professor for 18 years I was Psychiatric Consultant to the dentists and physicians of the U.N.C. Clinical Pain Program. In 1982 I co-founded Pain Resource Center, Inc., a company devoted to developing clincial evaluation tools in the field of chronic pain and TM disorders. I directed research programs which led to development of the "TMJ Scale" used by dentists and TMJ Specialists to screen for and measure the symptoms of temporomandibular disorders, and the 'Chronic Pain Battery' for chronic pain evaluation and treatment.